The Application Research On 64-sliced Computed Tomography In The Process Of MRECIST After TACE

Objective:To investigate the application value of 64-sliced computed tomography(MSCT)in the process of modified RECIST after Transcatheter arterial Chemoembolization(TACE)by Hepatic carcinoma(HCC)TACE preoperative and postoperative target lesion diameter measurement and volume measurement comparison,and Intrahepatic and extrahepatic lesion detection research.Material and methods:one hundred seventy patients with hepatic carcinoma(HCC)underwent 1 TACE cycles.Triphasic helical CT scans were performed at baseline,at 4 weeks after TACE procedure.Modified RECIST was regarded as the golden standard to evaluate the efficacy of TACE and to observe the images.The TACE preoperative image observations are include intrahepatic,extrahepatic lesion detection research,and Non-target lesions.After TACE image observations are about the iodized oil situation filling within the original intrahepatic target lesions,new intrahepatic lesion,extrahepatic lesion detection research,and Non-target lesions.The maximum diameter of the target lesion and volume were measured by two abdominal radiologists.The PACS was used to measure the biggest diameter and calculate the change rate before and after TACE.The mouse was used to delineate the target lesion contours layer by layer or every layer,the area of target lesion was measured by the computer software.Then the change rate before and after TACE were able to calculate.According to mRECIST criteria,the maximum diameter of the target lesion and volume were evaluated the efficacy.The both of results were contrasted and analyzed.The sum of diameter and total volume in targeted lesions before and after TACE measured by two independent radiologists were compared by independent t test.Correlation analysis was carried out between mRECIST efficacy after TACE which was calculated from the diameter and volume of targeted lesion by two independent radiologists.The number of each category was described in nominal indication.P<0.05 was regarded as significant difference.Results:The observed intrahepatic and extrahepatic lesions of results which were preoperative and postoperative TACE show that there were 196 targeted lesions in liver before TACE,there are 167 targeted lesions left after TACE,another intrahepatic 19 lesions were found after TACE,Three positive lymphonodis were observed after TACE with one in hepatic region and two at the side of aorta,there are 2 lung metastasis and 1 metastatic adrenal lesions were observed after TACE,there are 107 cases have no vein tumor thrombus before or after TACE,there were 53 vein tumor thrombosis,2 hepatic vein tumor thrombosis,3 inferior vena cava tumor thrombus,3 superior mesenteric vein tumor thrombus were observed before and after TACE.The shape of deposition of iodized oil in CT was analyzed after TACE.Seven tumor foci in 20 patients are belonging to Dense deposition type,the other 22 tumor foci iodized oil are incomplete filling.But tumor necrosis range and no significant strengthening stove arterial phase was found.All evidences are suggesting that the presence of active tumor has disappeared.150 patients with a total of 167 tumor foci CT scan showed that tumor foci iodized oil is incomplete filling.And 35 tumor foci lipoid are incomplete filling as Defected type,81 tumor foci iodized oil are incomplete filling as Clustered type,51 tumor foci iodized oil are incomplete filling as Rare or no deposition type.19 new tumor foci were found in 17 patients' liver after TACE.Its original 19 target lesions iodized oil is different filling type.2 target lesions were dense deposition type,5 target lesions were the defected type,7 target lesions were the clustered type,and 5 target lesions were the rare type 5.After statistical analysis,No significant difference was found in the results about the sum of targeted lesions measured and the sum of volume in targeted lesions by two independent radiologists.Results of the diameter measurement and volume measurement by the radiologist after TACE:(1)results of diameter measurement:Progressive disease(PD)was found in 28 patient.Stable disease(SD)was found in 70 patient.Partial response(PR)was found in 52 patients.Complete response(CR)was found in 20 patient,the release rate RR%was42.35%,the progressive disease rate PD%was 16.47%?(2)Results of volume measurement:progressive disease(PD)was found in 24 patient;stable disease(SD)was found in 66 patient.Partial response(PR)was found in 60 patient.Complete response(CR)was found in 20 patient,the release rate RR%was 47.05%,,the progressive disease rate PD%was 14.11%?The results of diameter measurement and volume measurement was positively correlated under the standard of mRECIST.(r=0.828,P<0.05)?Conclusion:MSCT volumetric measure no only increase for mRECIST evaluation of the new information,but also is better than the diameter line measurement on reflecting the changes in the size of the irregular tumor lesions.Unfortunately,applying the volume measurement is taken too much time,and more complicated operation than the diameter line measurement.All above Factors is its restrictions in the TACE postoperative follow-up.The MSCT relatively accurate evaluation for TACE postoperative mRECIST of the CR and PD,but PR,SD evaluation of the impact of iodized oil filling,irregular lumps measurement errors exist mRECIST,to be combined with clinical evaluation and other imaging.